Accountability, Equity, and Recovery: Rethinking Drug Monitoring in Treatment Courts

Treatment courts are under pressure to do more with less. The individuals you serve face complex challenges like substance use, mental health issues, trauma, and unstable housing. Helping people achieve long-term recovery and stay accountable means that drug monitoring must improve.

It needs to be more consistent, equitable, and reliable.

That starts by asking a fundamental question:

What should drug monitoring actually accomplish?

The Limits of Traditional Testing

Traditional testing methods—like observed urine collection—often fall short.

• They provide a snapshot, not a complete picture
• They’re easy to manipulate
• They require participants to travel frequently, often with little flexibility

These limitations frustrate both court staff and participants. Missed detection windows, diluted samples, and logistical hurdles can derail progress. Even worse, they may lead to inaccurate conclusions about someone’s commitment to recovery.

Courts need better tools—ones that reduce guesswork and support smarter decisions.

Why Long-Window Monitoring Matters

Monitoring drug use over a longer window helps courts respond based on patterns, not isolated incidents. This is especially helpful for participants in early recovery, when the risk for relapse is highest. Long-window monitoring can:

• Detect use at any time during the wear period
• Discourage short-term abstinence just before a test
• Reinforce accountability without increasing testing frequency

Put simply, it shifts the focus from catching mere slip-ups to gaining a better understanding of behavior.

Programs using longer detection windows often notice a change in participant engagement. People begin thinking in terms of progress, not just surviving from test to test. Courts that use sweat detection have reported better detection of weekend and binge use, especially among early-phase participants. According to the All Rise’s Adult Treatment Court Best Practice Standards (April 2025, page 21), it is recommended to have at least twice-weekly urine testing for participants with compulsive substance use disorders until they achieve early remission.

However, this testing frequency can put incredible strain on participants. As an alternative, courts are encouraged to employ testing strategies that extend the detection window, including devices like the PharmChek® Sweat Patch.

Dignity and Equity in Drug Testing

Drug testing should promote dignity, not reinforce stigma.

Observed urine collection is invasive, can trigger past trauma, and erode trust. Participants with jobs, kids, or transportation barriers may find it nearly impossible to comply with the multiple appointments required for UAs. This works against accountability and can add to the humiliation of their circumstances.

Modern drug testing should reduce those burdens, not add to them.

The latest best practice standards from All Rise (April 2025, page 27) emphasize the need for trauma-informed collection methods. They acknowledge that observed urine collection can retraumatize participants and recommend alternative strategies like PharmChek®, which is far less invasive and promotes dignity without compromising test integrity.

But fairness isn’t just about procedures. It’s about outcomes.

Testing protocols that rely on human observation, subjective judgment, or inconsistent access create unequal experiences. People without cars may miss tests more often. Those with trauma may avoid testing altogether. These aren’t excuses—they’re barriers. And better monitoring practices acknowledge that recovery isn’t one-size-fits-all.

This matters in both urban and rural areas, as we’ve discussed in the past. In rural courts, access is limited, and transportation is often a challenge. Frequent in-person testing can create unreasonable burdens on participants who lack access to vehicles, childcare, or flexible employment.

PharmChek®, worn continuously for 7 to 10 days, dramatically reduces required appointments. That lessens the chance of failure due to logistics and helps level the playing field.

Because our patch is tamper-evident and not subject to dilution, it reduces the need for same-gender observation and eliminates many procedural pitfalls. That makes it easier to offer a consistent experience that meets participants where they are.

Trustworthy Results Lead to Better Decisions

Testing data should build trust, not raise doubts.

Results often carry legal weight. They influence whether someone advances in a program, is sanctioned, or becomes eligible for family reunification. That means results must be reliable and scientifically confirmed, not just presumptively positive.

Courts and probation teams need to feel confident when they stand behind a result. And the participant needs to trust it, too. When both sides trust the data, it reduces conflict, supports collaboration, and opens the door to better outcomes.

How Confirmation Testing Protects Everyone

When results are challenged, science must hold up.

With confirmed lab data that identifies both the parent drug and its metabolites, court professionals are better equipped to explain the science, maintain fairness, and defend decisions in a legal setting.

The 2025 All Rise standards (page 28) emphasize the use of scientifically valid methods, specifically recommending confirmatory testing via gas chromatography/mass spectrometry (GC/MS) or liquid chromatography/tandem mass spectrometry (LC-MS/MS). These methods ensure drug test results are both clinically sound and legally defensible.

Confirmation testing reduces the risk of false positives (which can occur due to cross-reactivity, contamination, or presumptive misinterpretation) and false negatives (which may result from low drug concentrations, insensitive testing, or sample tampering).

LC-MS/MS provides a clear, accurate picture. It identifies substances and metabolites, quantifies concentrations, and withstands legal scrutiny in criminal and civil cases. It's essential when the stakes are high, whether the issue is program graduation, custody decisions, or court sanctions.

Accountability That Supports Recovery

Accountability works best when it supports, not punishes.

Take Tabitha, a graduate of adult drug court. She wore PharmChek® before taking her son on vacation. For her, wearing the patch wasn’t a burden. It was reassurance—a reminder that she had a reason to stay clean.

Tabitha credits PharmChek® for teaching her daily responsibility and self-care, which are critical to her sobriety. That kind of accountability helped rebuild her life and her self-worth.

Her story, and others like it, aren’t outliers. When monitoring is tied to personal goals, people rise to meet expectations. And when they do, courts are better positioned to celebrate success, not just enforce rules.

Staying Ahead of Changing Drug Trends

Modern substance use requires modern monitoring.

Synthetic opioids like fentanyl have changed the game. With short detection windows, standard testing can easily miss their use.

Someone might be clean on Friday, use on Saturday, pass a test on Monday, and overdose on Tuesday.

This risk increases with polysubstance use. According to national data cited in PharmChek®’s coverage of the fourth wave of the opioid crisis, fentanyl was involved in 66% of all U.S. overdose deaths in 2021, many alongside methamphetamine or cocaine.

Short detection windows and limited test panels miss these combinations. That means courts lose the ability to intervene before a fatal outcome. Longer detection windows and metabolite confirmation help detect use early, before relapse becomes a pattern.

Responding to a Shifting Legal Landscape

Consistency is key, especially with marijuana laws in flux.

The legalization of marijuana has created confusion across states and programs. Some courts have stopped testing for THC. Others continue, especially where any drug use violates supervision terms.

This inconsistency puts strain on testing programs. When expectations vary, the science must be solid. Confirmation testing—not assumptions—keeps the focus on fairness.

As discussed in this PharmChek® article, case managers report increased pushback from participants and families who question the need for THC testing. But for many programs, testing remains a condition of accountability, even when cannabis is legal elsewhere.

Addressing Common Objections

Outdated testing models carry real risks.

When programs stick with status quo testing, they risk:

• Misinterpreting participant progress
• Missing drug use that leads to preventable overdose
• Applying sanctions unfairly
• Losing trust with participants and community partners

Some teams worry about participant discomfort. Others raise concerns about cost or logistics. But many objections are rooted in habit—“This is how we’ve always done it.”

So it’s worth asking:

• Is our current system really working?
• Do we trust the data we’re using to make decisions?
• Are we helping or hindering participant success?

For many programs, switching to longer-window, confirmed testing has reduced administrative load. Fewer missed tests. Fewer collection events. Fewer contested results.

And with fewer conflicts comes more time to focus on the actual work of recovery support. PharmChek® integrates with CourtFact to make this transition easier.

According to SCRAM of California, "CourtFact simplifies the logistics of managing monitoring tools like the PharmChek® Sweat Patch while enhancing communication between the participant, service provider, and court team." Integration allows teams to track patch use, manage communication, and centralize documentation in one system, reducing errors and improving engagement.

Recovery Programs Need More Than Clean Tests

Effective drug testing should do more than flag drug use.

It should:

• Reduce barriers to compliance
• Encourage personal responsibility
• Support informed decision-making
• Provide consistent, defensible results

Treatment courts can’t afford to be passive. You have the opportunity—and the responsibility—to use tools that reflect the realities of modern substance use while supporting participant dignity, public safety, and long-term recovery.

Better monitoring won’t solve every challenge, but it can reduce friction, strengthen trust, and improve outcomes for everyone involved.

Now is the time to ask:

Do our current practices reflect what recovery-focused courts are meant to achieve?

Because accountability and compassion should never be in conflict.